Antibiotic Mouthwashes
Chlorhexidine gluconate (0.12% or 0.2%) is the most widely used and FDA-approved antimicrobial mouthwash for treating gingivitis, though it is not recommended for preventing oral mucositis in cancer patients. 1
Primary Antimicrobial Mouthwashes
Chlorhexidine Gluconate
- FDA-approved indication: Treatment of gingivitis between dental visits as part of a professional program, characterized by redness, swelling, and gingival bleeding upon probing 1
- Effective concentrations: Both 0.12% and 0.2% concentrations demonstrate comparable clinical and microbiological efficacy 2
- Recommended concentration: 0.12% chlorhexidine is preferred over 0.2% due to better patient acceptance, improved taste tolerance, and fewer discontinuations while maintaining equal antimicrobial effectiveness 3, 4
- Dosing: 10 mL rinse for 1 minute, twice daily, 30 minutes after tooth brushing 3
Chlorhexidine with Cetylpyridinium Chloride (CPC)
- Formulation: 0.12% chlorhexidine combined with 0.05% CPC provides equal efficacy to higher chlorhexidine concentrations with improved tolerability 3
- Advantages: Better patient tolerance regarding bleeding perception (95.5%), reduced burning sensation (13.6%), and superior taste acceptance (100%) compared to 0.2% chlorhexidine alone 3
Antimicrobial Mouthwashes NOT Recommended
For Cancer-Related Oral Mucositis
- Chlorhexidine: ESMO guidelines suggest against using chlorhexidine mouthwash for preventing oral mucositis in patients receiving radiation therapy for head and neck cancer 5, 6
- Iseganan antimicrobial mouthwash: Strongly recommended against for preventing oral mucositis in HSCT patients and head/neck cancer patients receiving radiation 5, 6
- PTA (polymyxin, tobramycin, amphotericin B) lozenges: Recommended against for preventing oral mucositis in radiation therapy patients 5
Clinical Applications by Indication
Periodontal Disease
- Primary use: Chlorhexidine is most effective as an adjunct when mechanical debridement is not possible 7
- Post-surgical: Chlorhexidine significantly reduces bacterial adherence to sutures after periodontal flap surgery compared to plain water 8
- Duration: Most effective for short-term use; concentrations above 0.2% unnecessarily increase side effects without added benefit 7
Gingivitis Treatment
- Mechanism: Chlorhexidine causes damage to bacterial cell membranes and at higher concentrations precipitates cytoplasmic proteins 2
- Efficacy: Demonstrates broad-spectrum antimicrobial activity against oral pathogens including Staphylococcus aureus, Streptococcus mutans, and E. coli 8
Important Caveats
Side Effects
- Most common: Tooth and tongue staining (most frequently reported patient complaint) 7, 3
- Other effects: Loss of taste, burning sensation of oral mucosa, subjective oral dryness 4
- Discontinuation: Higher concentrations (0.2%) lead to more treatment discontinuations due to side effect severity 4